Glossary of definitions, abbreviations, symbols and normal values

See also index for definitions in the text. a useful measure of aerobic capacity for Values in [square brackets] are from the USA monitoring endurance training, but of (all values are approximate). limited value in severe COPD because peak 2,3-DPG Enzyme in red blood cells, t in exercise levels are often reached below the chronic hypoxaemia, shifting O2 dissociation anaerobic threshold. In normal subjects, curve to right and allowing easier unload• anaerobic threshold can be increased by ing of O2 to hypoxic tissues. 25-40%. A Alveolar, e.g. P A02. Angioplasty Invasive but non-surgical dila• a Arterial, e.g. Pa02. tation of coronary artery stenosis, using ACBT Active cycle of techniques. catheter via femoral puncture, or laser. ACE inhibiters Angiotensin-converting en- Anoxia Synonymous with hypoxia, although zyme inhibiter drugs, for hypertension, implying a more complete oxygen lack. e.g. captopril, enalapril. AP Anteroposterior. ACPRC Association of Chartered Physio• APACHE Acute Physiology And Chronic therapists in Respiratory Care. Health Evaluation (scoring system to meas• ADL Activities of daily living. ure severity of illness). Adult respiratory distress syndrome Alterna• Apgar score Combined measurement of heart tive name for acute respiratory distress rate, respiratory effort, muscle tone, reflex syndrome. irritability and colour (scoring system to Aerosol Suspension of particles in a gas measure birth asphyxiation). stream. Therapeutic aerosols are for Apneustic breathing Prolonged inspiration humidification and drug delivery, other usually due to brain damage. aerosols spread some lung infections and Apnoea Absence of breathing for > 10 allow damage from noxious agents. seconds. AIDS Acquired immune deficiency syndrome. ARDS Acute respiratory distress syndrome. Air trapping Retention of inspired gas in Arteriovenous oxygen difference Assess• poorly ventilated areas of lung. ment of oxygen delivered to, and returning Airway closure Closure of small airways, from, tissue, related to metabolic rate and mostly in dependent lung regions during calculated from arterial and mixed venous expiration. . blood samples. Airway resistance Normal: 0.5-2.0 cmH20/llsec. Ascites Fluid in the abdominal cavity. Albumin Plasma protein responsible for pro• Aspiration (1) Inhalation of unwanted sub• viding most osmotic pressure in blood. stances (e.g. gastric acid, sea water) into Normal: 40-60 gil, [4.0-6.0 g/100ml]. the lungs, or (2) therapeutic removal of ~ albumin suggests malnutrition, blood fluid or gas from a cavity such as the loss, liver failure, nephrotic syndrome. pleural space. Anaerobic threshold Highest oxygen con• Atelectasis Alveolar collapse due to poor sumption during exercise, above which lung expansion or complete obstruction of sustained lactic occurs. Normally an airway. Glossary 313

Base deficit Negative base excess. tures outside lung that participate in breath• Base excess (BE) Normal: from -2 to +2 ing movements. mmolll. Closing capacity Volume at which airway BB 'Blue bloater' patient. closure begins (as lung volume is reduced Bicarbonate Normal 22-26 mmoUI. towards residual volume, dependent air• Biot's Irregular cycles of deep ways begin to close); rises with age until it gasps and apnoea. equals FRC at about 66 years in standing, BiPAP Bi-Ievel positive airways pressure. 44 years in supine. Bleb Collection of air under visceral pleura, Closing volume Closing capacity minus outside alveoli (see also bulla). residual volume. Blood culture Blood taken from a pyrexial Normal: 10% of vital capacity in young patient to identify responsible micro• people with normal lungs. organism. Age 65: 40% of Vc. bpm Beats per minute. Increases (i.e. becomes a greater propor• Bradypnoea Slow breathing. tion of FRC) with small airways dis• Bronchomalacia Degeneration of elastic and ease, smoking and extremes of age. connective tissue of trachea and bronchi. Clotting studies Bulla Collection of air inside distended Platelet count alveoli, over 1 em in diameter, caused by Normal: 140000-400000 mm-3 • alveolar destruction (see also bleb). Low enough to cause spontaneous bleed• CABG Coronary artery bypass graft. ing: 20000-30000. Cachectic Emaciated. Prothrombin time (PT) CAL Chronic airflow limitation, i.e. COPD. Normal: 12-30 seconds. Calcium Normal: 2.2-2.6 mmoUI. Expressed as internalized normalized ratio CCF Congestive cardiac failure. (INR) Ca02 Arterial oxygen content. Normal: < 1-1.3. Normal: 17-20 mU100ml. If on warfarin: 4--4.5 (pulmonary em• Cardiac enzymes Enzymes released from bolus), 2-4 (myocardial infarct), 1.8 damaged heart muscle after myocardial (postoperative ). infarction. With DIC: up to 1.5-2.2. Cardiac index Cardiac output divided by Expressed as activated partial thrombo• body surface area. plastin time (PIT) Normal 2.5-3.5 Uminlm2• Normal: 25-35 seconds. Cardiac output (0) Heart rate x stroke DIC: 50 seconds. volume (stroke volume depends on pre• CMV Controlled mandatory ventilation. load, afterload and contractility), i.e. CNS Central nervous system. amount of blood ejected by left ventricle CO Cardiac output. per minute. COAD Chronic obstructive airways disease Normal; 4-6 Umin at rest, up to 25 Umin on (= COPD). exercise. Collateral ventilation Exchange of inspired Catecholamines Collective term for com• gas between adjacent lung units. pounds having a sympathomimetic action, Colostomy Surgical creation of opening into e.g. adrenaline. large bowel. CF Cystic fibrosis. Compliance of lung Change in volume in Chest wall Rib cage, diaphragm, abdominal response to change in pressure (aV/ap). contents and abdominal wall, i.e. struc- Normal: 0.09-0.40 UcmH20. 314 Glossary

Compliance of lung measured on IPPV Erythrocytosis Polycythaemia. tida.l volume _ PEEP. ETC02 End-tidal CO2• plateau aIrway pressure Normal: 4-6%. Consolidation Replacement of alveolar air by EIT Endotracheal tube. substance of greater density than air. Eucapnia Normal PaC02• COPD Chronic obstructive pulmonary dis- FBC Full blood count. ease. FEF25-75 Forced expiratory flow in middle half of CPAP Continuous positive airways pressure. expiration. CPR Cardiopulmonary resuscitation. FET Forced expiration technique. Creatinine Electrolyte in plasma or urine, FEV 1 Forced expiratory volume in one second. formed from muscle breakdown, excreted FP2 Fraction of inspired oxygen (F10 2 of 0.6 = by kidneys. 60% inspired oxygen). Normal in plasma: 50-100 fLmol/l, [0.6- 1.2 mg/100 mIl. FRC Functional residual capacity. i in hypovolaemia or kidney failure, FVC Forced vital capacity. i i in septic shock. Glottis Vocal apparatus of the larynx. CSF Cerebral spinal fluid. Glucose level in blood CT Computed tomography. Normal: 3.0-5.5 mmolll. CV02 Venous oxygen content. i in stress, i i in diabetis mellitus, ~ in Normal: 12-15 ml/100 ml. liver failure or starvation. CVP Central venous pressure. Goodpasture's syndrome Combination of lung Normal: 1-6 mmHg or 5-12 cmH20. haemorrhage and nephritis. CXR Chest X-ray. GOR Gastro-oesophageal reflux. Dehydration low blood volume (see also Haematocrit (packed cell volume) Concentra• hypovolaemia) tion of red blood cells in blood, indicates DIC Disseminated intravascular coagulation. oxygen-carrying capacity of blood. DNA Deoxyribonucleic acid. Normal: 40-45%. DNR Do not rescusitate. ~ in anaemia, i.e. < 38%, i in poly• D02 See oxygen delivery. cythaemia, i.e. > 55%. Duty cycle See TlfTOT• Haemoglobin (Hb) Respiratory pigment in red DVT Deep vein thrombosis. blood cells, combines reversibly with oxygen. Dysphagia Pain and/or difficulty in swallow- Normal for men: 14.0-18.0 g/100 mI. ing. Normal for women: 11.5-15.5 g/100 mI. ECC02R Extracorporeal carbon dioxide removal. ~ in anaemia, i in polycythaemia. ECG Electrocardiogram. Hb Haemoglobin, see above. ECMO Extracorporeal membrane oxygenation. -ectomy Removal. HCO-3 Bicarbonate. EIA Exercise-induced . HDU High dependency unit. ER02 See oxygen extraction ratio. HFV High frequency ventilation. Left ventricular end-diastolic pressure Left HFJV High frequency jet ventilation. ventricular preload. HFO High frequency oscillation. Endotoxin Pyrogenic toxin in bacterial cell which HFPPV High frequency positive pressure vent- increases capillary permeability. ilation. Endotoxic shock Septic shock. HIV Human immunodeficiency virus. Eosinophil White blood cell associated with HLT Heart lung transplant. hypersensitivity reactions, i in allergies such H:L ratio Ratio of power in high and low as extrinsic asthma. frequency bands of electromyogram of Glossary 315

respiratory muscle, t with respiratory muscle expiratory position. fatigue. Inspiratory:expiratory ratio Numerical expres• HME Heat moisture exchanger. sion of duration of inspiration relative to HR Heart rate. expiration. Hypematraemia i serum sodium. Inspiratory force See MIP. Hyperosmolar Containing high concentration of IMV Intermittent mandatory ventilation. osmotically active ingredients. Intrapulmonary pressure Alveolar pressure Hyperreactivity of the airways Heightened (p.4). sensitivity to a variety of stimuli, prominent in Intrathoracic pressure Pleural pressure (p. 4). asthma, sometimes present in COPD, bron• IPPB Intermittent positive pressure breathing. chiectasis, CF, , LVE IPPV Intermittent positive pressure ventila- Hyperthermia Core temperature > 4OSC. tion. CO2 removal in excess of CO2 IRT Immune reactive trypsin - antibody production, producing PaC02 < 4.7 kPa identified in CF screening. (35mmHg). IRV Inspiratory reserve volume. Hypokalaemia t potassium. IVOX Intravascular oxygenation Hypopnoea Shallow slow breathing. JVP Jugular venous pressure. CO2 production in excess of K See potassium. CO2 removal, producing PaC02 > 6.0 kPa Kartagena's syndrome Triad of bronchiecta• (45mmHg). sis, sinusitis and dextrocardia, associated Hypovolaemia Low blood volume, with adverse with primary ciliary dyskinesia. haemodynamic outcome. kPa Kilopascal. Hypoxia classifications Kussmaul breathing Deep sighing breathing Hypoxaemic hypoxia: due to t PaOz, often seen in patients with metabolic aci• Anaemic hypoxia: due to t Hb in blood, or dosis. t ability of Hb to carry oxygen e.g. I Litre anaemia, sickle cell anaemia, Lactate in blood (serum lactate) Hypoperfusion or stagnant hypoxia: due to Normal: < 1 mmol/l. t 0021 e.g. heart failure, PVD, vaso• Severe oxygen debt, poor prognosis constriction. 2.5-3.0. Histotoxic hypoxia: due to inability of Laparotomy Surgical incision through damaged tissues to accept oxygen de• abdominal wall. livered, e.g. cyanide poisoning, septic Larynx Cylindrical tube connecting pharynx shock. and trachea, formed by cartilages and IABP Intra-aortic balloon pump. containing vocal cords. Iatrogenic Causing or exacerbating a problem by Left ventricular end-diastolic volume medical intervention. (L VEDV) Determinant of preload, depends ICP Intracranial pressure. on venous return to left ventricle, circulating lCU Intensive care unit. blood volume and efficiency of left atrial I:E See inspiratory:expiratory ratio. contraction. Ileostomy Surgical creation of an opening into LVEDV See above. the ileum. LVF Left ventricular failure. Infection Presence of micro-organisms or their IJ-m Micron, i.e. lO-6 m. products invading normally sterile tissue (see MAP Mean arterial pressure. also sepsis). Mast cells Connective tissue cells involved in Inspiratory capacity Volume inspired during hypersensitivity reactions, which release maximum inspiration from resting end- histamine in response to specific stimuli. 316 Glossary

MOl Metered dose inhaler. while working with industrial substances. Mean arterial pressure Average arterial blood OHFO Oral high frequency oscillation. pressure. Oliguria ~ urine output, i.e. < 20 mllh Normal: 65-100 mmHg. (normal 50-60 mVh). Mean corpuscular haemoglobin (MCH) -os copy Visual examination of interior of an Amount of Hb in red blood cells. organ. Mean corpuscular volume (MCV) Reflects size Osmolality Number of osmotically active of red blood cells. particles per kg of solvent. ~ MCV (small RBCs): iron deficiency. Osmolarity Number of osmotically active t MCV (large RBCs): vitamin B12 or folate particles per litre of solution. deficiency. -ostomy Formation of artificial opening on to MEFso Maximum expiratory flow in mid• skin surface. expiration. -otomy Incision. MEP Maximal expiratory pressure. Oxygen consumption (V02) Amount of oxy• Normal: 100 cmH20. gen consumed by tissues each minute. < 40 cmH20: inadequate cough. Normal at rest: 250 mVmin (if contribut• MET (metabolic energy expenditure) Metabolic ing values normal, i.e. CO 5 Vmin, Hb unit representing amount of oxygen con• 15 g/100 ml, 5a02 97%, 5,,02 75%). sumed at rest. 600 mVmin: critical illness; 3600 mVmin: Normal 3.5 m1 oxygen/kg body weight! maximum exercise in unfit males; min. 5000 mVmin: maximum exercise in fit Maximum MET levels (multiples of resting males. V02) - estimated V02 max -;- resting Oxygen delivery (D02) Volume of oxygen V02• delivered to tissues each minute. MI Myocardial infarction, i.e. death of portion of Normal: 550-1000 mVmin. heart muscle due to myocardial ischaemia. Calculation: cardiac output x arterial MIP Maximum inspiratory pressure (assessment oxygen content. of respiratory muscle strength). Oxygen demand Amount of oxygen needed Normal: minus 100-130 cmH20 (men), by cells for aerobic metabolism, estimated minus 70-100 cmH20 (women). by measurement of V02 • Typical value in hypercapnic COPD: Oxygen extraction ratio Ratio of oxygen minus 55 (men), minus 40 (women). consumption to oxygen delivery (V021002), Minus 20: poor weaning outcome, minus indicating efficiency of tissues in extracting 0-20: inadequate . oxygen. MMEF Maximum mid-expiratory flow. Normal: 25%. mmHg Millimetres of mercury. > 35% implies excessively high oxygen MMV Mandatory minute ventilation. extraction to meet metabolic needs. Mucoviscidosis Cystic fibrosis. Calculation: cardiac output -;- Ca02. Neutrophils Cells which release tissue• Oxygen flux % oxygen that reaches tissues. damaging enzymes as part of inflammatory Oxygen transport Oxygen delivery. process. Oxygen uptake Oxygen consumption. NFR Not for resuscitation. Ozone Gas that provides a protective layer to NIPPV Nasal (or non-invasive) intermittent the earth's atmosphere, but at ground level positive pressure ventilation. it causes inflammation in people with NSAID Non-steroidal anti-inflammatory drug. hyperreactive airways. Occupational lung disease Disease due to Pso P02 at which 50% of haemoglobin in inhalation of dust, particles, fumes or gases blood is saturated with oxygen, quantifies Glossary 317

shift in dissociation curve (high value PCWP Pulmonary capillary wedge pressure suggests slow affinity of Hb for oxygen). (= PAWP). Normal: 27-28 mmHg. PD Postural drainage. PA Posteroanterior. PE Pulmonary embolus. P A-a02 (alveolar to arterial oxygen gradient) PEEP Positive end-expiratory pressure. Difference in partial pressures of alveolar PEFR Peak expiratory flow rate (peak flow). oxygen (P A02) and arterial oxygen (Pa02)' PEmax Maximum expiratory pressure at the Normal on room air: < 10 mmHg (re- mouth. flecting normal anatomical shunt). PEP Positive expiratory pressure. i in respiratory disease (due to ~ VA/Q pH Hydrogen ion. mismatch), Phlebotomy/venesection Therapeutic with• i on exercise (up to 20-30 mmHg), i in drawal of blood. the elderly (up to 30 mmHg), i on PImax Maximum inspiratory pressure at the supplemental oxygen (up to 100 mmHg mouth (see MIP). on 100% oxygen). PIP Peak inspiratory pressure. Pack years Number of years of smoking Plasma osmolarity Normal: 280--300 m osmolll. multiplied by number of packs smoked -plasty Reconstruction. each day, e.g. smoking one pack a day for Platelet count See clotting studies. 30 years = 30 pack year history. Platypnoea Difficulty breathing while sitting Packed cell volume See PCV. up. Pancoast's tumour Tumour of upper lobe Plethoric Florid complexion due to excess red affecting brachial plexus, sometimes indic• blood cells. ated by wasting of small muscles of the Pneumonitis Inflammation of lung tissue due hand. to chemical or physical insult. Pa02 Partial pressure of oxygen in arterial Polysomnography Recording of physiological blood. parameters during sleep. PaC02 Partial pressure of CO2 in arterial Polyuria i urine output, i.e. > 100 mllh. blood. POMR Problem oriented medical record. PAP Peak airways pressure (= peak inspir• Potassium (K) Electrolyte in plasma or urine. atory pressure). Normal in plasma: 3.5--5.0 mmolll. PAP Pulmonary artery pressure. ~ K (hypokalaemia) predisposes to car• Normal: 10-20 mmHg. diac arrhythmias, i K (hyperkalaemia) Parenchyma Gas exchanging part of lung, suggests kidney failure. largely alveolar tissue. Poudrage Pleurodesis. Parenchymal lung disease Disease affecting PP 'Pink puffer' patient. alveolar walls, e.g. interstitial lung disease, Prader-Willi syndrome Combination of pneumonia, pulmonary TB, ARDS. obesity, hypotonia and impaired cognitive PAWP Pulmonary artery wedge pressure. ability, associated with respiratory prob• Normal: 5--12 mmHg. lems due to reduced diaphragmatic excur• Paw Mean airway pressure. sion, upper airway soft-tissue collapse and PCA Patient controlled analgesia. sleep apnoea. PCP Pneumocystis carinii pneumonia. PT Prothrombin time (see clotting studies). PCV Packed cell volume. Psittacosis Infectious disease of birds trans• Normal: 0.40-0.50 (men), 0.36--0.47 mitted to humans as atypical pneumonia. (women). PtC02 transcutaneous oxygen tension. i in polycythaemia, ~ in anaemia. PtcC02 Transcutaneous carbon-dioxide ten• Equivalent to haematocrit. sion. 318 Glossary

PTT Partial prothrombin time (see clotting QT cardiac output. studies). Radiolabelling Monitoring of mucus clear• Pulmonary hypertension i pulmonary ance by inhalation of radiolabelled aero so• artery pressure, i.e. > 25 mmHg (mean) land following up its clearance by gamma atrest or 30 mmHg on exercise, in presence camera. of cardiac output < 5 l!min. RAP Right atrial pressure. Pulmonary vascular resistance Normal: Raynaud's phenomenon of the lung Vaso• 25-125 dyn.s.cm-5 . spasm in the lungs associated with Ray• Pulse pressure Difference between systolic naud's syndrome. and diastolic pressures (raised in hyperten• REM (rapid eye movement) sleep Most sion), related to stroke volume, therefore restorative phase of sleep cycle. gives indication of blood flow. Resection Surgical cutting out. Normal: 40-70 mmHg. Respiratory inductive plethysmography 20 mmHg: dangerously poor tissue per• Spirometry for ventilated patients, includ• fusion. ing measurement of lung volume to detect Pulsus paradoxus Transient drop in systolic intrinsic PEEP. CO d d pressure on inspiration due to expansion of Respiratory quotient (RQ) 2 pro uce d. pulmonary vascular bed on inspiration. oxygen consume Normal: 10 mmHg. Normal: 0.8, expired minute volume > 10 mmHg = severe acute asthma (due being slightly less than inspired to laboured breathing causing excess minute volume because less CO2 is negative pressure in chest) or cardiac excreted than O2 absorbed. tamponade. RFTs Respiratory function tests. Pump (ventilatory/respiratory) Muscles and RQ See respiratory quotient. nerves of respiration, chest wall, respir• RR . atory centre. RT A Road traffic accident. PVD Peripheral vascular disease. Sa02 Saturation of haemoglobin with oxygen. PV02 mixed venous oxygen tension. Sepsis Clinical response characterized by i Normal: 35-40 mmHg. temperature and WBC, caused usually but Minimum acceptable: 28 mmHg. not always by infection. PVC02 mixed venous CO2 tension, Sepsis syndrome Preseptic shock state. Normal: 46 mmHg. SGAW Specific airways conductance. Q blood flow. Shunt Perfusion without ventilation (see Q02 Oxygen delivery (alternative abbreviation Qs/Qt). to 002). SIMV Synchronized intermittent mandatory QRS complex The deflection of the ECG ventilation. caused by depolarization of the ventricles, Small airways Terminal and respiratory consisting of an upward, or positive deflec• bronchioles, i.e. less than 1 mm diameter, tion (R) preceded and followed by negative unsupported by cartilage and therefore deflection (Q and S). influenced by transmitted pleural pres• QS shunted blood. sures. Qs/Qt shunt, i.e. fraction of cardiac output SOB . not exposed to gas exchange in pulmonary Sodium (Na) Electrolyte in plasma or urine. capillary bed, measured by comparing Normal in plasma: 135-147 mmo1Jl, [135- arterial and mixed venous blood. 147 mEqIl]. Normal: 2-4%. ! Na (hyponatraemia): excess water 20%: respiratory failure, 50%: ARDS. administration or inappropriate ADH Glossary 319

secretion, t Na (hypernatraemia): Transthoracic pressure Pressure across chest dehydration. wall, i.e. pleural pressure minus atmos• Standard bicarbonate Bicarbonate corrected pheric pressure. for a normal PaC02, similar to bicarbonate Trendelenburg position Head down tilt. in a person with normal acid-base status. Torr Measurement of pressure used in the Sternotomy Surgical cutting through the USA, equivalent to mmHg. sternum. U & E Urea and electrolytes. Surgical emphysema Subcutaneous emphys• Urea Electrolyte in plasma or urine, formed ema. from protein breakdown and excreted by Surfactant Phospholipid protein complex kidneys. that lines alveoli, lowers surface tension Normal in plasma: 3-7 mmolll. and maintains patency. >8 dehydration; 18-20: hypovolaemia; SVR See systemic vascular resistance. 55: kidney failure. SV02 Mixed venous oxygen saturation. V Volume of gas. Normal: 75%. VAS Visual analogue scale. Syncope Transient loss of consciousness, e.g. v Venous. faint. v Volume of gas per unit time, i.e. flow (dot Systemic vascular resistance (SVR) indicates time derivative). Normal: 800-1400 dyn.s.cm-s. v Mixed venous (line indicates mean or Calculation: (MAP-CVP/cardiac output) mixed value). X 79.9. Vso Flow rate half-way through expiration. < 300 suggests septic shock. VA/Q Ratio of alveolar ventilation to perfu• TED Thromboembolic disease. sion. Tension-time index Measurement of inspir• Normal: 0.8 (411min for alveolar vent- atory muscle fatigue (Ramonatxo 1995). ilation, 51/min for perfusion). Thoracoplasty Surgery used historically for VC Vital capacity. pulmonary TB, involving rib resection and Vn Volume of dead space gas. localized lung collapse to allow healing. VnlVT Dead space in relation to tidal volume. Thrombocytopaenia ~ platelet count. Normal: 0.3-0.4, i.e. 30-40% of each T1/TTOT Respiratory duty cycle, i.e. ratio of breath does not contribute to gas inspiratory to total respiratory cycle time, exchange. short T1 in relation to TTOT indicating ~ 0.6: critical increase in VD • tidal volume and t dead space, suggesting VF Ventricular fibrillation. inspiratory muscle fatigue. VE (Expired) minute volume. TLC Total lung capacity. Normal: 5-711min. TLCO Total lung transfer capacity for carbon 200 lImin has been recorded on exercise. monoxide. VC02 Carbon dioxide production. TPN Total parenteral nutrition. V02 See oxygen consumption. Tracheal tube Endotracheal or tracheostomy V02ID02 See oxygen extraction ratio. tube. V02max Oxygen consumption at maximum Tracheostomy Artificial opening into the exertion, reflecting aerobic capacity. trachea. Increases with fitness, declines with Tracheotomy Operative formation of a tra• advancing age but rate of decline is slower cheostomy. in physically active people. Transairway pressure Pressure between Normal: > 25 mllkg/min, or 25 times the mouth and alveoli. resting level. Normal: 5 cmH20. See also anaerobic threshold. 320 Glossary

VT Tidal volume. Conversion of mmHg to kPa Valsalva manoeuvre Expiration against mmHg = kPa x 7.5. closed glottis. mmHg kPa Vasopressor drug Drug that causes vasocon• 150 20 striction of capillaries and arteries. 120 16 WBC See white blood cell count. 105 14 Wegener's granulomatosis Triad of upper 90 12 respiratory tract lesions, pulmonary dis• 75 10 ease and glomerulonephritis. 60 8 Well-year of life Concept which includes 40 5 morbidity and mortality, e.g. if disease 30 4 reduces quality of life by a half over 2 15 2 years, patient has lost one full well-year. White blood cell count (WBC) Conversation of mmHg to cmH20 Normal: 4-10 X 109/1, [4000--10 OOO/mm--3]. mmHg cmH20 WOB Work of breathing. 5 6.8 10 13.6 20 27.2 30 40.7 40 54.3 Appendix A: Transatlantic dictionary

British North American

Adrenaline Epinephrine Accident and Emergency (A & E) Emergency Room (ER) ASAP (as soon as possible) Stat Cardiac arrest Code Chest drains Chest tubes Chronic obstructive airways diseases Chronic obstructive pulmonary disease Community care Home care Consultant Staff person Drip IV Drugs Medication Entonox Nitronox (USA) ECG EKG Frame Walker General practice Primary care/family practice Hospital Health Sciences CenteriFacility Houseman/woman Intern Lignocaine Lidocaine mm of Hg (unit of pressure) torr Nil by mouth NPO Patient's notes Patient's chart Passive or active movements Range of motion Peak expiratory flow rate Maximum expiratory flow rate Queue Line up Referral Consult Registrar Resident Respiratory physiotherapist Part physical therapist, part respiratory therapist (USA) RTA (road traffic accident) MY A (motor vehicle accident) Salbutamol Albuterol (USA) Sluice Utility room Splint Cast Stick Cane Theatre Operating room or OR Walk or mobilize Ambulate Ward Floor 1st floor 2nd floor Appendix B: Postural drainage positions

1. UPPER LOBES 4. LOWER LOBE l(a) Apical segments of both upper lobes• 4(a) Apical segments of both lower lobes - sitting upright prone, head turned to side l(b) Posterior segment of right upper lobe• 4(b) Anterior basal segments of both lower left-side-Iying, turned 45° towards lobes - supine, foot of bed raised 46 ern prone (18 ins) l(e) Posterior segment of left upper lobe - 4(e) Posterior basal segments of both lower right-side-Iying, turned 45° towards lobes - prone, head turned to side, foot prone, shoulders raised 30 ern (12 ins) of bed raised 46 em (18 ins) l(d) Anterior segments of both upper lobes 4(d) Medial basal segment - right-side• - supine lying, foot of bed raised 46 ern (18 ins) 4(e) Lateral basal segment - left-side-lying, 2. MIDDLE LOBE foot of bed raised 46 ern (18 ins) Lateral and medial segments - supine, quarter turned to left, foot of bed raised 35 ern From: Downie, P.A. (1987) (ed.) Cash's Text• (14 ins) book of Chest Heart and Vascular Disorders for Physiotherapists, Faber, London, with per• 3. LINGULA mission. Superior and inferior segments - supine, quarter turned to right, foot of bed raised 35 ern (14 ins) Appendix B 323

l(a)

He) 1 (d) ~

Appendix B Postural drainage positions. 324 Appen dIX" B

4(b)

4(c)

4(e) Appendix C: Resources and organizations

Action for Sick Children, Argyle House, 29- Surrey, CR5 3LT. (01737) 557997, fax 31 Euston Rd, London NW1 2SD, UK. (01737) 556671. (0171) 8332041. Booklets and references on Canadian Lung Association, Suite 908, postoperative pain. 75 Albert St, Ottawa, Ontario, KIP 5E7. + 1 American Association for Respiratory Care, (613) 237 1208. 11030 Ables Ln, Dallas, Texas, 75229. +1 Carbon monoxide biofeedback for smoking (214) 243 2272. cessation, contact ASH, above. American Lung Association and American Carers National Association, 20 Glasshouse Thoracic Society, 1740 Broadway, New Yard, London EC1A 4JS, UK. (0171) 490 York, NY 10019-4374. +1 (212) 315 8700. 8818, fax (0171) 490 8824. Includes 'Superstuff' children's asthma CPAP and BiPAP equipment: education programme. Medicaid, Hook Lane, Pagham, Sussex ASH (Action on Smoking and Health), 109 P021 3PP, UK. (01243) 267321, fax (01243) Gloucester Place, London W1H 3DA, UK. 262556. (0171) 935 3519, fax (0171) 935 3463. ResCare, 68 Milton Park, Abingdon, Oxon Association of Chartered Physiotherapists in OX144RX, UK. (01235) 862997, fax (01235) Respiratory Care (ACPRC), c/o CSP, 14 831336. Bedford Row, London WC1R 4ED, UK. Respironics, 530 Seco Rd, Monroeville, PA (0171) 306 6666. 15146, USA. Asthma and Allergy Foundation of America, Cystic Fibrosis Research Trust and Associ• 1717 Massachusetts, Washington, DC, ation of Cystic Fibrosis Adults, 5 Blyth Rd, USA. + 1 (202) 265 0265. Bromley, Kent BR1 3RS, UK. (0181) 464 7211, fax (0181) 313 0472. Asthma Society of Canada, PO Box 213, Flutter: Clement Clarke, Airmed House, Station K, Toronto, Ontario M4P 2G5. + 1 Edinburgh Way, Harlow, Essex CM20 (416) 9779684. 2ED. (01279) 414969, fax (01279) 635232. BACUP (British Association of Cancer United Guillain-Barre Syndrome Support Group, Patients), 3 Bath Place, London EC2A 3JR. Foxley, Holdingham, Sleaford, Lincs, (0171) 613 2121. NG34 8NR, UK. (01529) 304615. BiPAP equipment see CPAP. Headway (Head injuries association), 7 King British Lung Foundation, 8 Peterborough Edward Court, King Edward Street, Mews, London SW6 3BL, UK. (0171) 371 Nottingham NG1 lEW. (0115) 924 0800, 7704. Includes Breathe Easy Club (self-help support group (0115) 967 9669, fax (0115) club for patients) and Lung and Asthma 9240432. Information Agency (epidemiological data• Inspiratory muscle trainers: base for health staff). Medix, Medix House, Catthorpe, Lutter• British and Sleep Apnoea Associ• worth, Leics, L176DB, UK. (01788) 860366. ation, The Steps, How Lane, Chipstead, Healthscan, Cedar Grove, NJ 07009, USA. 326 Appendix C

Laryngectomy patients: Ozone alert (information on daily air pol• National Association of Laryngectomee lution levels in UK), (0800) 556677. Clubs, 6 Rickett Street, London SW6 1RU, Patient booklets: UK. (0171) 381 9993. Allen & Hanburys, Greenford, Middlesex International Association of Laryngecto• UB6 OHB, UK. (0181) 990 9888, fax (0181) mees, 777 Third Ave, New York, NY 10017, 9904375. USA. + 1 (212) 371 2900. Glaxo, Box 13398, Research Triangle Park, Liver patients: The British Liver Trust, NC 27709, USA. Central House, Central Avenue, Ransones PEP masks: Europark, Ipswich IP3 9QG, UK. (01473) Astra Tec, PO Box 13, Stroud, Glos G15 276326, fax (01473) 276327. 3DL, UK. (01453) 791763. Manometer for testing bag-squeezing pres• Astra Tec Inc, 1000 Winter St, Suite 2700, sures: Vital Signs, 60 Gladstone Place, Waltham, MA 02154, USA. Brighton, Sussex BN2 3QD, UK. (01273) Henleys, 39 Brownfields, Welwyn Garden 625188, fax (01273) 624836. City, Herts AL7 IAN, UK. (01707) 333164, MIP measurement - Precision Medical, fax (01707) 334795. Thornton Road Industrial Estate, Picker• Primary Ciliary Dyskinesia Support Group, ing, North Yorkshire, UK. (01751) 477577. 67 Evendons Lane, Wokingham, Berks Motor Neurone Disease Association, PO Box RG41 4AD, UK. 246, Northampton NN1 2PR, UK. (01604) Pulmocare (low carbohydrate feed for respir• 250505, helpline (0345) 626262, 24 hrs atory patients): Abbott Laboratories, (01604) 22269, fax (01604) 24726. Supplies Abbott House, Moorbridge Rd, Maiden• Breathing Space Kit to reduce fears in final head, Berks SL6 8JG, UK. (01628) 773355. stages of disease. Ross Division, Abbott Park, N. Chicago, IL National Asthma Campaign, Providence 60064-3500, USA. House, Providence Place, London, N1 ONT, UK. (0171) 226 2260, help line (0345) Quitline (smoking cessation helpline in the 010203, fax (0171) 704 0740. UK); (0171) 487 3000. National Heart, Lung and Blood Institute, Self Help Guide: directory of self-help groups in Building 31, Room 4A18, National Insti• Britain, by Gann, R. and Knight, S. (1988), tutes of Health, Bethesda, MD 20982, USA. Chapman & Hall, London. NIPPV equipment: Shuttle audio tape and booklet; £25 to Respir• Medicaid, Respironics, Rescare, see CPAP. atory Medicine Dept, Glenfields General Thomas Respiratory Systems, 33 Half Hospital, Groby Road, Leicester LE3 9QP, Moon Lane, Herne Hill, London SE24 9JX, UK. (0116) 287 1471. UK. (0171) 737 5881, fax (0171) 737 5234. Spinal Injuries Association, Newpoint PneuPAC, Crescent Rd, Luton, Beds, LU2 House, 76 St James Lane, London N10 OAH, UK. (01582) 453303, fax (01582) 3DF, UK. (0181) 444 2121. 453103. Vibrator (electric chest pad): Niagara Manu• Oscillator: Hayek oscillator, Medicom, 9 Bur• facturing, Colomendy Industrial Estate, roughs Gardens, London NW4 4AU, UK. Rhyl Rd, Denbigh, Wales LL16 TS UK. (0181) 203 9686, fax (0181) 203 4758. (01745) 813666. Appendix D: Articles by patients

Armstrong, A (1977) Living on a mechanical Nicholson, E.M. (1975) Personal notes of a respirator. Guardian, 6 Sept. laryngectomee. Am. J. Nurs., 75 (12), 2157- Bevan, P.G. (1964) Cholecystectomy in a 8. surgeon. Lancet, 1, 214-15. Neuberger, J. (1991) The patient's viewpoint. Bevan, J.R. (1969) Polyneuropathy. Lancet, 1, Respir. Med., 85 (suppl.B), 53-6. 1310. Nursing Times (1981) Who am I? Where am I? Brooks, D.H.M. (1990) The route to home Why do I hurt so much? Nurs. Times, 77 ventilation: a patient's perspective. Care (15), 633-5. Crit. Ill, 6, 96-7. Redfern, S. (1985) Taking some of my own Clark, KJ. (1985) Coping with Guillain-Barre syndrome. Int. Care Nurs., 1, 13-18. medicine. Care Crit. Ill, 1, 6-7. Farrow, J. (1995) Cystic fibrosis - it's a funny Ruiz, P.A (1993) The needs of a patient in name. Respir. Dis. Pract., 12(1), !'Ki. severe status asthmaticus. Int. Crit. Care Gandy, AP. (1968) An attack of tetanus. Nurs., 9, 28-39. Lancet, 2, 567-8. Shovelton, D.S. (1979) Reflections on an Heath, J.V. (1989) What the patients say. Int intensive therapy unit. Br. Med. J., 2, 737- Care Nurs., 5, 101-8. 8. Holden, T. (1980) Patiently speaking. Nurs. Standing, C. (1987) The treatment of our son Times, 76(24), 103!'Ki. with cystic fibrosis. J. Roy. Soc. Med., 80 Houston, J.E. (1988) Physiotherapy from a (suppl. 15), 2-4. patient's point of view. S.A.J. Physiother., Thomson, L.R. (1973) Sensory deprivation: a 44, 38--41. personal experience. Am. J. Nurs., 73, 266- Kinnear, W.J.M. (1994) Assisted Ventilation at 8. Home - a Practical Guide, Oxford Medical Publications, Oxford, Chapter 8: A Villaire, M. (1995) ICU from the patient's patient's view of living with a ventilator, point of view. Crit. Care Nurse, 15 (1), 80--7. pp.85-93. While, A (1985) Personal View. Br. Med. J., Lancet (1969) At the receiving end. Lancet, 2, 291, 343. 1129-31. Wilkinson, J. (1987) The experience and Lancet (1969) Cardiac arrest. Lancet, 2, 262-4. expectations of parents of a child with Marsh, B. (1986) A second chance. Br. Med. cystic fibrosis. J. Roy. Soc. Med., 80 (suppl. J., 292, 67!'Ki. 15), 7-8. Appendix E: Articles on outcome measures for pulmonary rehabilitation

Brannon, F.J., Foley, M.W., Starr, J.A. et al and Rehabilitation (Eds F. Haas and K. (1993) Cardiopulmonary rehabilitation: Basic Axen), Williams and Wilkins, London. Theory and Application, 2nd edn, F.A. Davis, (Outcomes: ~ hospitalization, ~ A & E Philadelphia. visits, i quality of life.) (Outcomes: i survival, i exercise capa• Hodgkin, J.E., Zorn, E.G. and Connors, G.L. city, ~ hospitalization, p.7.) (1993) Pulmonary rehabilitation: guidelines to Bryant, A. (1993) Quality of life variables success, 2nd edn, Lippincott, Philadelphia. influenced by outpatient pulmonary re• (Outcomes: ~ costs by 1/5 (p.551), $217610 habilitation. Resp. Care, 38, 1230. saved in one hospital (p.533), 25% patients Cockcroft, A.E., Saunders, M.J. and Berry, assumed full-time employment (p.555), ~ G. (1981) Randomised controlled trial of hospitalization (p.550), chapter on cost rehabilitation in chronic respiratory disabi• lity. Thorax, 36, 200-3. effectiveness. ) (Outcomes: i 12-minute distance, main• Holden, D.A., Stelmach, K.D., and Curtis, tained on follow-up.) P.S. (1990) The impact of a rehabilitation Couser, J.I., Martinez, F.J., and Celli, B.R. program on functional status of patients (1993) Pulmonary rehabilitation that with chronic lung disease. Respir. Care, 35, includes arm exercise reduces metabolic 332-41. and ventilatory requirements for simple (Outcome: i walking distance by average arm elevation. Chest, 103, 37-41. 27%.) Donner, C.F. (1992) Pulmonary rehabilitation Hudson, L.D., Tyler, M.L. and Petty, T.L. in COPD with recommendations for its (1976) Hospitalization needs during out• use. Eur. Respir. ]., 5, 266-75. patient rehabilitation for severe chronic (Outcomes: 25% patients: > lO% ~ SOB airway obstruction. Chest, 70, 606-lO. and/or> lO% i 6-minute walk.) (Outcome: ~ hospitalization.) Flanigan, K.S. (1991) Outcome of a 3-day Make, B. (1990) Pulmonary rehabilitation - pulmonary rehabilitation programme. what are the outcomes? Respir. Care, 35, Respir. Care, 36, 1271. 329-31. (Short programme outcomes: i ADL, i (Literature review of outcomes.) . confidence.) Make, B. (1994) Collaborative self-management Giddings, D.J. (1994) Outcome evaluation strategies for patients with respiratory dis• of a respiratory rehabilitation program. ease. Respir. Care, 39, 566-77. Physiother. Can., 46(2) (supp!.), 81. (Outcomes: i walking distance, i ADL.) (Outcomes: i workload by 30%, i Haas, F. and Axen, K. (1991) Pulmonary V02max by 9.2%, 6-minute distance i by Therapy and Rehabilitation, Williams and 21 %, i ADL, i social and emotional Wilkins, London, p.336. (Cost savings > function.) $2600/patient/year. ) Murray, E. (1993) Anyone for pulmonary Haggerty, M.C. (1991) Home care for the rehabilitation? Physiotherapy, 79, 705-lO. person with COPD, in Pulmonary Therapy (Outcomes: i exercise capacity, ~ Appendix E 329

hospitalization, t symptoms, t anxiety (Outcome: $2625 savings/patient/year.) and depression, i quality of life.) Schleifer, T.J. (1994) Patient responsibility in Niederman, M.S., Clemente, P.H., Fein, an innovative COPD therapy program. A.M. et al. (1991) Benefits of a multi• Physiother. Can., 46(2) (suppl), 81. disciplinary pulmonary rehabilitation pro• (Outcomes in severe disease: i ADL, t gram. Chest, 99, 798-804. exacerbations, t anxiety.) (Outcomes: i endurance, t SOB, t Tougaard, L., Krone, T., Sorknaes, A. et al. oxygen consumption.) (1992) Economic benefits of teaching Ojanen, M. (1993) Psychological changes in patients with COPD about their illness. patients participating in a COPD rehabili• Lancet, 339, 1517-20. tation program. Respiration, 60, 96-102. (Outcome: t use of health services.) (Outcome: i well-being, t symptoms.) Vale, F., Reardon, J.Z. and ZuWallack, R.L. Reardon, J. (1994) The effect of comprehens• (1993) The long term benefits of outpatient ive outpatient pulmonary rehabilitation on rehabilitation on exercise endurance and dyspnea. Chest, 105, 1046-52. quality of life. Chest, 103, 42-5. (Outcome: t SOB.) (Outcomes: i exercise capacity, i quality Petty, T.L. (1993) Pulmonary rehabilitation in of life.) perspective. Thorax, 48, 855--62. Zeballos, R.J. (1984) The effect of a 3-week (Outcome: i survival.) physical rehabilitation program on exercise Roselle, S. and Amico, F.J. (1982) The effect tolerance and performance in patients with of home respiratory therapy on hospital COPD. Am. Rev. Respir. Dis., 129, 4(2), readmission rates in patients with COPD. A275. Respir. Care, 27, 1194-9. (Outcome: i exercise capacity.) Further reading

Armstrong, R.F., Bullen, CL. Cohen, S.L. et al. Petty, T.L. and Nett, L.M. (1984) Enjoying Life with (1991) Critical Care Algorithms. Oxford Medical Emphysema, Lea and Febiger, Philadelphia. Publications, Oxford. Pilbeam, S.P. (1992) Mechanical Ventilation, C V. Brannon, F.J., Foley, M.W., Starr, J.A. and Black, Mosby, Missouri. M.G. (1993) Cardiopulmonary Rehabilitation: Basic Prasad, S.A. and Hussey, J. (1995) Paediatric Theory and Application, 2nd edn, F.A. Davis, Respiratory Care, Chapman & Hall, London. Philadelphia. Pryor, J.A. (ed.) (1991) Respiratory Care, Churchill Cameron, LR. and Bateman, N.T. (1990) Respir• Livingstone, Edinburgh. atory Disorders, Edward Arnold, London. Rees, J. and Price, J. (1995) ABC of Asthma, BMJ Carter, B. (1994) Child and Infant Pain, Chapman & publications, London. Hall, London. Schechter, L. Berde, CB. and Yaster, M. (1993) Cohen, M. and Hoskin, T.M. (1988) Cardiopulmon• Pain in Infants, Children and Adolescents, Williams ary Symptoms in Physical Therapy, Churchill and Wilkins, Baltimore. Livingstone, New York. Singleton, M.C and Branch, E.F. (1990) Advances Fried, R. (1993) The Psychology and Physiology of in Cardiac and Pulmonary Rehabilitation, Haworth Breathing, Plenum Press, New York. Press, New York. Frownfelter, D.L. (1987) Chest Physical Therapy and Spagnolo, S. V. (1994) Handbook of Pulmonary Drug Pulmonary Rehabilitation, Year Book Medical Pub• Therapy, Little, Brown, New York. lishers, Chicago. Sykes, K (1995) Respiratory Support, BMJ publica• tions, London. Irwin S. and Tecklin, J.S. (1995). Cardiopulmonary Timmons, B.H. and Ley, R. (1994) Behavioral and Physical Therapy, Mosby, Missouri. Psychological Approaches to Breathing Disorders, Haas, F. and Axen, K (1991) Pulmonary Therapy Plenum Press, New York. and Rehabilitation, Williams and Wilkins, Lon• Tobin, M.J. (1991) Respiratory Monitoring, Chur• don. chill, Livingstone, Edinburgh. Hodgkin, J.E., Connors, G.L. and Bell, CW. Webber, B.A. and Pryor, J.A. (1993) Physiotherapy (1993) Pulmonary Rehabilitation - Guidelines to for Respiratory and Cardiac Problems, Churchill Success, Lippincott, Philadelphia. Livingstone, Edinburgh. Holmes, O. (1993) Human Acid-base Physiology, Weinstock, D. (ed.) (1990) Normal and Abnormal Chapman & Hall, London. Breath Sounds, Springhouse Audio, Pennsylvania Kinnear, W.J.M. (1994) Assisted Ventilation at Home (book and tape). ISBN 0--87434-201-5. - a Practical Guide, Oxford Medical Publications, Wells, P.E., Frampton, V. and Bowsher, K (1994) Oxford. Pain Management and Control in Physiotherapy; Landay, M.J. (1987) Interpretation of the Chest 2nd edn, Heinemann, London. Roentgenogram, Little, Brown & Co, Boston. West, J.B. (1995) Respiratory Physiology, 5th edn, Luce, J.M., Pierson, D.J. and Tyler, M.L. (1993) Williams and Wilkins, Baltimore. Intensive Respiratory Care, Saunders, London. White, G.C (1992) Equipment Theory for Respiratory Mackenzie, CF. (ed.) (1989) Chest Physiotherapy in Care, Delmar, New York. the Intensive Care Unit, Williams and Wilkins, Widdicombe, J. and Davies, A. (1991) Respiratory London. Physiology, Edward Arnold, London. Moser, KM. Ries, A.L., and Sassi-Dambron, D.E. Wilkins, R.L., Sheldon, R.L. and Krider, S.J. (1991) Shortness of Breath: a Guide to Better Living (1995) Clinical Assessment in Respiratory Care, and Breathing, 4th edn, C V. Mosby, Missouri. CV. Mosby, Toronto. Nunn, J.F. (1993) Applied Respiratory Physiology, Williams, S.J. (1993) Chronic Respiratory Illness, Butterworth, London. Routledge, London. Petty, T.L. (1982) Intensive and Rehabilitative Respir• Zadai, CC (1992) Pulmonary Management in Physical atory Care, Lea and Febiger, Philadelphia. Therapy, Churchill Livingstone, Edinburgh. References

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Page numbers appearing in bold represent figures, page numbers appearing in italic represent tables.

Abdomen, palpation of 31 Allergy 59, 60 in children 289 Abdominal paradox 27 Almitrine 102 drugs for 67 Abscess 39, 41, 83 Alpharantitrypsin 3, 53 education for 62-6 Absorption atelectasis 90, 223 Alveolar-arterial oxygen exercise for 66 Acetylcysteine 102 difference 12 exercise-induced 62 Acid-base balance 10, 13-14 Alveoli 1 extrinsic 60 Acidosis 10 Ambu bag 253 in ICU 269 metabolic 14 Amiloride 102 intrinsic 60 respiratory 14 Aminophylline 100 nocturnal 62, 64 Acquired immune deficiency Anaerobic Asystole 238 syndrome, see AIDS metabolism 159 Atelectasis 32, 109, 112, 181 Active cycle of breathing 134 threshold 18, 34 absorption 90, 223 Activities of daily living 163 Analgesia 175-8, 241 in ICU 221, 253, 255 Acupressure 68, 155, 171, 172 pre-emptive 173 postoperative 170-1, 181, 186 Acupuncture 64, 165 see also Pain on x-ray 37, 43 Acute respiratory distress Angina 22, 189, 206 Atopy 59 syndrome 281 Angiography 41 Atrial ectopic 238 Advance directive 218 Ankylosing spondylitis 81 Atrial fibrillation 238 Aegophony 31, 32 Antibiotics 102 Atrial flutter 238 Aerochamber 105 Anticholinergics 100, 101-2 Atrovent, see Ipratropium Aerosol 104 Antimuscarinics 101 Audit 305 Afterload 240 Apnoea in infants 302 Auscultation 28-31 Ageing 15 Arrhythmias 247 Autogenic drainage 135, 136 see also Elderly people see also ECG AIDS 75,83 Arterial blood gases 9-14 Bagging, see Manual, Air bronchogram 39 Asbestos 3 hyperinflation Air embolism 264 Asbestosis 78 Bag-squeezing, see Manual, Air hunger 206 Aspergillosis 74 hyperinflation Airway Aspiration 2, 23, 280 Balloon pump 242-3 for cardiac arrest 260 Assessment 20-50 Barotrauma 222, 255 for mechanical ventilation 219 in children and babies 287, Barrel chest 25 for suction 142, 143 296 Base excess 14 see also Tracheal tube in ICU 246 Beclomathasone 100 Airway closure 9, 15 postoperative 180 Beclovent 100 Airway pressure release for rehabilitation 149 Becotide 100 ventilation 226 self 305 Bed rest 18 Alarms 264 Assist mode of ventilation 226 Bennett, see IPPB Albumen 247 Asterixis 25 Beta-blockers 159, 241 Alcohol 98 Asthma 50-70 Betaz-adrenergics 101 Alexander technique 165 acute 60-2, 68 Beta2-agonics 100, 101 Alkalosis 10 breathing techniques for 66 Beta2-stimulants 101 metabolic 14 brittle 60 Bicarbonate 10, 14 respiratory 14 cardiac 85 Bigeminy 238 358 Index

Bilevel positive airways Bronchoconstriction 2 Cheyne-Stokes 27,84 pressure 126 see also Bronchospasm Children 286-302 for ARDS 284 Bronchodilators 67, 100-1, 293 dying 202 for weaning 232 Bronchogram 41 inhalers for 107 Biofeedback 64, 154, 165, 31 Chronic bronchitis 51-5, 57 232 Bronchopleural fistula 111, 184 see also COPD Biopsy 107 Bronchopulmonary dysplasia Chronic lung disease of Bird, see IPPB 301 prematurity 301 Bird fancier's lung 78 Bronchoscopy 107 Chronic obstructive pulmonary Bleeding, see Haemorrhage Bronchospasm 2,53,255 disease, see COPD Blood gases 9-14 in asthma 60, 269 Cilia 2 Blood lactate 18 Budesonide 100, 106 Circulation Blood pressure 21 Buffer system 13 bronchial 8 effect of exercise 18 Bulla 39,56 pulmonary 8, 9 in head injury 276 Bums 279 Clinitron bed 252 after heart surgery 186 Closed circuit catheter 258 in ICU 234, 247 Cancer 82-3 Closing volume 15, 16 in rehabilitation 159, 189 see also Malignancy Clotting disorders 143 Blue bloater 57 Capnography Clubbing 25 Breathing 6 for hyperventilation Coach 115 abdominal 114, 157 syndrome 208, 210 Coarctation of aorta 191 ataxic 27 in ICU 223, 255 Collateral ventilation 15, 293 bronchial 29, 32 Carbonic acid 13 Colloid 240 deep 112 Carcinoma, see Cancer Commando procedure 195 diaphragmatic 114 Cardiac arrest 259 Communication 248-50 laboured 25 Cardiac output 18 see also Dying; Tracheostomy paradoxical 27, 273 in ICU 221, 247, 248 Compliance of lung 5, 16 pursed lip 27, 157 measurement 237 Computed tomography 41 Breathing control 114 Cardiac tamponade 263 see also CT scan Breathing exercises Cardiopulmonary bypass 185, Condenser humidifier 130 for lung volume 112-15 190 Confusion 197 postoperative 181 Cardiopulmonary resuscitation Congestive heart failure 86 for secretions 132, 134--6 21,260 Consolidation 29, 32, 109 Breathing pattern 25 Cardiorespiratory arrest in on x-ray 37, 38, 41 Breathing rate, see Respiratory infants 302 Constipation 18 rate Cardiovascular disease 85 Continuous positive airways Breathing re-education 124, Cardioverter defibrillator 239 pressure, see CPAP 156-7,210 Catheters 140-1, 257, 258 Control Breathlessness 147-9, 201 Central venous pressure 234--6 breathing 114 assessment/measurement of see also CVP of respiration 3 22, 149-50 Cepacia 70 Controlled mandatory drugs for 101 Cerebral oedema 274 ventilation 224, 225 management 154 Cerebral perfusion pressure 275 Contusion 272 Breath sounds 28-30, 32 Cerebrospinal fluid 178, 275 COPD 51, 54, 59 in ICU 248 CF 69,70-4 in ICU 269 see also Auscultation education in 71 Coronary artery bypass graft 186 Bricanyl 100 gene therapy for 71 Cor pulmonale 53,54 Bronchial breathing 29, 32 physiotherapy for 72 Corticosteroids, see Steroids Bronchiectasis 68-70 screening for 71 Coude-tipped catheter 257 Bronchiolitis 290 Chest drains 80, 184, 186, Cough 2-3, 138-40 obliterative 191 192-5 assessment of 22 Index 359

drugs for 102 Diffusion 7-8, 12, 50 Energy conservation 163 in dying people 201 Disability 149 Entonox 178 facilitation 138 Disseminated intravascular Epidural 178 paroxysms 139 coagulation 281 Epiglottis 2 postoperative 181 Diuretics 103, 240 Epiglottitis 290 suppression 139 DNase 72 Epilepsy 262 CPAP 115-19 Doppler 172, 237 Equal pressure point 135 for CF 68,74 Dopram 103 Ergometry 34 for children 288 Doxapram 103 Ethics 218 for head injury 280 Drowning 280 Evaluation 128, 303-11 for OSA 84 Drugs 99-107 Exercise for pneumonia 75, 76 in ICU 240 in ICU 252 postoperative 186 see also Medication isometric 159 for weaning 231 Dying 198-203 isotonic 159 for work of breathing 125 Dynamic compression of for lung volume 110 Crackles 30, 32 airways 55, 135 physiology of 18 Crash, see Cardiac arrest Dysphagia 82 postoperative 182, 187 Crepitations, see Crackles Dyspnoea 147 testing 33-5 Croup 290 training 157-62, 188 Cryoanalgesia 178 ECG 237-9 see also Mobilization Crystalloid 240 Education Exhalation, see Expiration CT scan 283 for asthma 62 Expansion 31,32 Cuirass 127 for hyperventilation Expiration 4 CVP 240 syndrome 208 forced 27 Cyanosis 24 for rehabilitation 150, 188 Expiratory muscles 4, 163 Cystic fibrosis, see CF for staff 310 Expiratory reserve volume 44 Elasticity 16 Extracorporeal CO2 removal Dead space 6, 221 Elastic recoil 4 244 Death, see Dying of chest wall 4 Extracorporeal gas exchange Decortication 185 of lungs 4 244, 283, 295 Deep breathing 6, 7 Elderly people 197 Extracorporeal membrane Deep vein thrombosis 172, 178, see also Ageing oxygenation 244 181 Electrocardiogram, see ECG Extubation 232 Defence 1-3 Electrolytes 33 Exudate 79 Dehydration 33, 129,201 Embolism, see Air embolism; see also Hydration Fat embolism; Pulmonary Farmer's lung 78 Depression 152, 171, 197, 216 embolism Fat embolism 264 respiratory 175-6 Emergencies 259-66, 301 Fatigue 140, 171, 180 159 EMLA cream 178 on weaning 232 DialysiS 86, 255 Emphysema 32, 36, 55-8 see also Diaphragm Diaphragm 4 interstitial 223 FEF25-75 48 fatigue 6, 27, 146 subcutaneous 31, 184 Fentanyl 178 paralysis 81, 186, 270 surgical, see Subcutaneous Fever 21, 180 after surgery 182, 186 emphysema FEVtIFVC 44, 47 weakness 6, 27 Empyema 74,184 Fibrosing alveolitis 78 on x-ray 37 End-inspiratory hold 113 Fibrosis 32, 39 see also Inspiratory muscles; Endotracheal tube 219 Flail chest 272, 273 Respiratory muscles see also Tracheal tube Flatulence 171 Diary End-tidal carbondioxide 208, Flixotide 100 for asthma 64, 65, 66 210,278 Flow-by 227 for rehabilitation 161 Endurance 49, 159 Flow curve 224 360 Index

Flow-trigger 227 Hands 25 Hyperventilation 148 Flow volume curve 249 Head box 93 manual 253 Flow volume loop 47, 48 Head injury 273 Hyperventilation syndrome 13, Fluids 21 Head and neck surgery 195 188,204-14 in ICU 240, 245, 247 Heart block 238 Hypnotherapy 64, 165 Fluticasone 100 Heart failure 33, 85--6 Hypocapnia 10 Flutter 138 in COPD 53 Hypocarbia, see Hypocapnia Forced expiration technique 134 effect on JVP 28 Hypotension, postural 33, 171, Forced expiratory volume in on exercise 149 180, 197 one second, see FEV1IFVC Heart rate 21, 253 Hypoventilation 12, 13, 148 Forced vital capacity, see FVC maximum 160 nocturnal 81, 84 Foreign body 84, 261 Heart surgery 185 Hypovolaemia 171, 247, 252 Fractured ribs 4, 255, 272 Heat moisture exchanger 130, Hypoxaemia 10, 11, 13, 89 Functional residual capacity 16, 219 in babies 293 44,45,46 Heimlich manoeuvre 261 postoperative 170 FVC44 Heliox 97 Hypoxia 10, 11 171 Hypoxic vasoconstriction 9, 11, Gas dilution 48 High-frequency jet ventilation 38 Gas transfer 49, 57 229 see also TLCO High-frequency oscillation 127, I : E ratio 25, 227 Gastric tonometry 237 229 IgA 3 Gastro-oesophageal reflux 87-8 High-frequency ventilation IgE 59 in asthma 62 229-30 Ileus, paralytic 171, 223 in children 288 Hila 37 Impairment 149 cough in 23 HIV 75 Incentive spirometry 115, 181 see also GOR Homans sign 172 Incisions 183 Glosso-pharyngeal breathing Home management 166, 187 Indrawing 27 127 Hoover's sign 27, 56 Induced sputum 76 Glottis 3 Hot water bath, see Infection Goals 152, 159 chest 88, 166, 171 Humidification Goblet cells 53 drugs for 101 Human immunodeficiency GOR 87-8 in ICU 218 virus, see HIV in CF 73 wound 171 Humidification 129-30 in pneumonia 78 Inflammation 53 in the ICU 219 see also Gastro-oesophageal in asthma 59 reflux before physiotherapy 131 drugs for 99 Guillain-Barre syndrome 270 Hydration 33, 129 Inhalation, see Inspiration Gut 223 Hydrocortisone 100 Inhalers 104, 105 see also Steroids Inolators 241 Haematemesis 24, 74 Hyperbaric oxygen 96 Inotropes 241 Haemodialysis 86 Hypercapnia 10, 13 Inspiration 4 Haemofiltration 86 permissive 270, 283 Inspiratory: expiratory ratio, Haemoglobin 10 Hypercarbia, see Hypercapnia see I : E ratio Haemoptysis 24, 262 Hyperinflation 55, 56 Inspiratory muscles 6, 81 Haemorrhage 172, 196, 262 in ICU 223 fatigue 148, 162, 231 Haemothorax 79 manual, see Manual, weakness 81, 162 Handicap 149 hyperinflation see also Diaphragm; Handling Hyperpnoea 148 Respiratory muscles ICU patients 251 Hyperreactivity 58, 59 Inspiratory muscle training 66, infants 296 Hypertension, pulmonary 53, 73, 162-3, 272 patients in pain 175 54, 103 Inspiratory reserve volume 44 Index 361

Intall00 Malignancy 184 Mobility Intensive care 215--44 see also Cancer bed 180 Intermittent mandatory Malnutrition 56 see also Mobilization ventilation 225 postoperative 182 Mobilization Intermittent positive pressure see also Nutrition for lung volume 110 breathing, see IPPB Mandatory minute ventilation postoperative 180 Internal mammary artery 186 226 for secretions 132 Interstitial lung disease 32, 39, Manual see also Exercise 78-9 hyperinflation 253--6, 258, 297 Modes of ventilation 224 Intra-aortic balloon pump 242-3 hyperventilation 253 Monitoring 232-9, 247, 276-7 Intracranial pressure 275 sigh 256 Morphine 102, 175 Intravascular oxygenation 244 techniques 133, 256 Motivation 151, 248 Intravenous feeding 239 therapy 155 Mucociliary escalator 2 Intraventricular haemorrhage ventilation 253 Mucolytic drugs 102 301 Mast cells 59, 99 Mucus 53, 170 Inverse ratio ventilation 226 Mastectomy 197 trap 143 IPPB Maximum inspiratory pressure see also Secretions; Sputum for lung volume 119-21 49 Multisystem failure 281 for sputum retention 138 Maximum mid-expiratory flow Muscle relaxants 242 for work of breathing 68, 125 48 Muscles IPPV, see Mechanical Maximum voluntary ventilation accessory 4, 27 ventilation 46,49 see also Inspiratory muscles, Ipratropium 100, 103, 106 Mechanical aids Expiratory muscles; for lung volume 115-20, 112 Respiratory muscles for secretions 136-8 Myocardial infarction 188 Jet nebulizer 130 for work of breathing 124-8 Jet ventilation 229 Mechanical ventilation 219-32, Jugular venous pressure 28 Naloxone 178 248 Narcotics 176 for babies 295 see also Morphine Kaposi sarcoma 83 malfunction 264 Nasal cannula 92 Keyhole surgery 169 patient distress 265 Nasal catheter 92 Kidney disease 86 Mechanics of breathing 3--6 Nasal intermittent positive Kyphoscoliosis 25, 81 Meconium aspiration 300 pressure ventilation 125-6 Medication for weaning 232 Laerdal bag 253 for pain 175 Nasogastric tube 118, 180 Laparoscopy 182 for respiratory care 99-107 Nausea 171 see also Keyhole surgery see also Drugs Nebuhaler 104, 105 Laparotomy 182 MEFso 48 Nebulizers 104 Laryngectomy 195 Mesothelioma 83 in ICU 242 Laryngospasm 140 Metastases 21 Nedocromyl sodium 103, 105 Larynx 2 Metastises 21 Negative pressure ventilation Lavage 107 Metered dose inhaler 104, 105 127 Left ventricular failure 85 in ICU 242 Neonates 292-302 see also Heart failure METS 160 Nerve block 177 Liquid ventilation 244 Midazolam 241 Neuromuscular blocking agents Literature criticism 307 Minitracheostomy 148 242 Liver disease 87 Minute ventilation, see Minute Neuromuscular disease 81-2, Living wills 218 volume 270 Lobectomy 184 Minute volume 44, 227 Neurophysiological facilitation Lung function tests, see Mixed venous blood 236 114 Respiratory function tests Mixed venous oxygenation 236 Nicotine 17 362 Index

Nicotine contd long term therapy 94 Phlebotomy, see Venesection patches 154 masks 91 Phrenic nerve injury 186 Nijmegen questionnaire 209 portable 96 Phrenic nerve stimulation 49 Nitric oxide 103, 300 saturation 9, 233 Pickwickian syndrome 84 Nitrogen washout 48 tension 9, 233 Pink puffer 57 Nitrous oxide, see Entonox toxicity 90 Plethora 24, 53 Nodal ectopic 238 transport 15 Plethysmography 48 Nodal rhythm 238 uptake 15 Pleural effusion 32, 79-80 Non-rebreathing bag 253 on x-ray 40, 43

Nose 2 PA-a02 12 Pleural rub 30 Nutrition 97-9, 162 Pacemaker 180, 239 Pleurectomy 185 in leu 239 Pain 17~0 79 see also Malnutrition assessment 22 Pleurodesis 185 in children and infants 291, Pneumobelt 127 Obesity 16 294 Pneumoconiosis 78 Obesity hypoventilation in dying people 201 Pneumocystis carinii syndrome 84 Palpation 31-3 pneumonia 75 Obliterative bronchiolitis 191 Pancuronium 242 Pneumonectomy 184, 185 Obstructive disease 51, 52, 53 Panic attacks 166, 213 Pneumonia 75-8, 112 Obstructive sleep apnoea 83 Paradox, abdominal 27, 61 aspiration 77 Occupational therapy 163 see also Breathing broncho- 75 Oedema 25,54-5 Paralysis 251, 252, 271 legionella 77 drugs for 103 by drugs 241-2, 270, 278 lobar 75 Oesophagectomy 192 Paroxysmal nocturnal dyspnoea nosocomial 77 On calls 266 22 pneumocystis carinii Operations, see Surgery Partial pressure of carbon pneumonia 75 Opiates 176, 178 dioxide 10 Pneumonitis 77 see also Morphine Partial pressure of oxygen 9 Pneumonmediastinum 284 Oral high frequency oscillation PAWP 240 Pneumotachograph 47 127,229 . see also Pulmonary artery Pneumothorax 4,32,80-1 Orthopnoea 22 wedge pressure tension 263, 270 Oscillators 127, 138 Peak expiratory flow rate, see on x-ray 38, 43, 284 Osteoporosis 18, 74, 149 Peak flow Poisoning 280 Outcome evaluation 306 Peak flow 43, 46-7, 63, 67 Polycythaemia 24, 53, 54 Overdose, see Poisoning Pectus carinatum 25 Positioning Oximetry 233 Pectus excavatum 25 in children and infants 288, on exercise 34, 149 PEEP 227-9 248 297 Oxygen 89-97 with bagging 256 in leu 252, 256, 284 acute therapy 93, 95 intrinsic 55, 223, 255, 269 for lung volume 110-11, 112 concentrator 96 PEP 104, 106, 136-7, 163 postoperatively 180, 186 consumption 15, 50, 247, 256 Percussion 133-4, 156 for work of breathing 122-4 maximum 34, 158, 160 in leu 256 Positive expiratory pressure, see content 10 in infants 298 PEP cost of breathing 6 Percussion note 8-9 Post-nasal drip 23 delivery 15, 237, 282 Percussors 138 Postoperative care, see Surgery demand 15 Perfusion 8-9 Postural drainage 132-3 desaturation 233 gradient 8, 9, 221, 222 for children and infants 288, dissociation curve 10-11 Permissive hypercapnia 270, 298 extraction 15, 18 283 in leu 256 hyperbaric 96 pH 10, 14 Postural hypotension 15, 18, liquid 96 Pharynx 2 33, 171, 180, 197 Index 363

Posture 24, 158, 187 Quadriplegia 271 see also Oxygen, saturation Potassium 247 Questionnaire Sarcoidosis 78 Prednisolone 100 for assessment 151 Scleroderma 78 Prednisone 100 for hyperventilation Secretions 2, 249 Preload 240 syndrome 208 to clear 128--44, 181, 256-9 Pre-operative management 172 for outcome evaluation 306 see also Mucus; Sputum for children 290 Sedatives 241 Pressure Radiolabelling 128 Segmentectomy 184 alveolar 4 Radionuclide imaging 40 Seizure 262 central venous 234 Rebreathing bag 253, 254 Septic shock 281 intrathoracic 4 Rebreathing mask 93 Sexuality 153 left atrial 234 Recession, see lndrawing Shock 280 mean airway 224 Recurrent laryngeal nerve 184 Shortness of breath mean arterial 234, 275 Rehabilitation scale 161 peak airway 224, 248 cardiac 187 see also Breathlessness plateau 224, 227 pulmonary 146-68 Shunt, pulmonary 10, 11, 90 pleural 4 Relaxation 156, 164, 189, 210 Shuttle test 34 Sickle cell anaemia 87 pulmonary artery 234 Renal, see Kidney disease 309 Sigh 227, 256 right atrial 234 Research Residual volume 45, 46 Silent chest 30, 61 transdiaphragmatic 49 Resistance, airflow 5 37 transmural 4 Respiration 6 Sinus bradycardia 237 vascular 247 261 Sinus rhythm 238 Pressure sores 251 Respiratory centre 3 Sinus tachycardia 237 Pressure support 225, 226 Respiratory distress syndrome Six minute distance 34 Pressure volume curve 5 300 Sleep 15, 19, 28, 122 Primary ciliary dyskinesia 74 Respiratory failure 13, 88 in leU 216, 245 Propanolol 159 Respiratory function tests 43-50 studies 49 Propofol 241, 246 Respiratory insufficiency 88 Sleep apnoea 83 Pseudomonas 24 Respiratory muscles 3 Sleeve resection 184 Pulmonary artery pressure 234, see also Diaphragm Small airways 47 235,240 Respiratory pump 3 Smoking 17-18, 153-4, 158 Pulmonary artery wedge Respiratory rate 25, 227 Smoke inhalation 279 pressure 235, 236 Retinopathy of immaturity 294 Sodium bicarbonate 132 Pulmonary capillary wedge Rheumatoid disease 78 Sodium cromoglycate 100 pressure 236 Rib fracture 4, 255, 272 Spacers 104, 105 12, 86, Rib springing 115 Spinal cord injury 271 264 Right atrial pressure 234 Spirogram 147 diagnosis 40 Right ventricular failure 86 Spirometry 147 postoperative 172, 181 see also Heart failure Sputum 128-9 Pulmonary hypertension 53, Rocking bed 127 assessment for 23-4 54, 103 Rotahalar 104, 105 drugs for 102 Pulmonary oedema 85-6 induced 76 assessment of 32, 33, 234, Salbutamol 100, 101, 159 specimen 143 236 Saline see also Secretions; Mucus neurogenic 274 for humidification 132 Stair climbing and suction 143 hypertonic 132 for exercise testing 34 on x-ray 38, 43 instillation 258, 299 for training 161 Pulse pressure 247 Salmeterol 100, 101, 102 Standards 304 Pulsus paradoxus 62 Sa02 Status asthmaticus 62 Pyrexia, see Fever in leU 247 Steam inhalation 129 364 Index

Sternotomy 185 Temperature Type II respiratory failure 81, Steroids 99-100, 104 in babies 294 88 28 peripheral 246 see also Auscultation see also Fever Ultrasonic nebulizer 130 Strength 49 Tension pneumothorax 263 Upper lobe diversion 9, 38 Stress 122, 164 Terbutaline 100 Urine retention 17, 18 in asthma 64 Theophylline 100, 101 in ICU 215, 217, 248 Thermodilution 237 in infants 294 Thoracic expansion exercises Vascular markings on x-ray 38 postoperative 172 113 Vasodilators 103, 241 28, 143 Thoracocentesis 79 Vena cava obstruction 83 Subcutaneous emphysema, see Thoracoscopy 183 Venesection 53 Emphysema see also Keyhole surgery Venous admixture 12 Suction 140-3 Thoracotomy 112, 183 Ventilation 6-7 in children 289 Tidal volume 44, 227 collateral 137 in ICU 256 Tilade 100 drugs for 103 in infants 298 TLCO 49, 57, 149 gradient 7, 8, 221, 222 high-frequency 229-30 Supraventricular tachycardia Tonometry, gastric 237 liquid 244 237 Total lung capacity 44, 45, 46 manual 253 Surface markings 26 Total lung transfer capacity for mechanical, see Mechanical Surface tension 4,5 carbon monoxide, see ventilation Surfactant 5, 7, 293, 300 TLCO Ventilation-perfusion ratio 9, Surgery 169-97 Total parenteral nutrition, see 11,12 abdominal 182 Intravenous feeding in mechanical ventilation 221 for children 290 T-piece 232 Ventilation-perfusion scan 40, head and neck 195 Trachea 33, 36 42 heart 185 Tracheal tube 219, 220, 247 Ventilator, see Mechanical lung 185 see also Endotracheal tube; Tracheostomy ventilation pleural 185 Ventolin, see Salbutamol Sv02247, 253 Tracheal tug 33 Tracheostomy 195-7 Ventricular assist device 243 see also Mixed venous Ventricular ectopic 238 oxygenation for IPPV 219 long term 127 Ventricular fibrillation 238 Swallowing 81, 201, 239 removal 232 Ventricular tachycardia 238 Swan-Ganz 234 with respiratory arrest 262 Venturi mask 91 Swedish nose 130 Transcutaneous monitoring Vibrations 133-4, 156 Sympathomimetics 101 233 in ICU 256, 257 Symptoms 22 Transcutaneous nerve for infants 298 Synchronized intermittent stimulation 179 Vibrators 138 mandatory ventilation 225, Transfer factor 49 Visual analogue scale 226 Transplantation 189 for breathlessness 150 Systemic lupus erythematosis Transtracheal catheter 92 for children 291 78 Transudate 79 for pain 174 Trauma 272 Vital capacity 43, 49 Tachypnoea 148 Treadmill 34, 160 in neuromuscular disorders Tactile resonance 31, 32 Triflo 115 81,270 Tactile vocal 31, 32 Trigeminy 238 Vitamin C 98, 102,252 Tamponade 263 Tuberculosis 85 Vocal resonance 31, 32 Tank ventilator 127 Turbohaler 104, 105 Voice sounds 31 TB, see Tuberculosis Turning, see Handling Volumatic 104, 105 TED stockings 182 Type I respiratory failure 88 Volutrauma 223 Index 365

Vomiting 180 Weaning 231-2 Work of breathing 5-6 VAIQ, see Ventilation-perfusion for COPD 255,269 to decrease 121--8 ratio Wedge pressure, see Pulmonary in infants 293, 296 artery wedge pressure Xanthines 100, 101 Wasted perfusion 11 Wedge resection 184 X-rays 35--43 Wasted ventilation 11 22, 30, 32 in ICU 247 Waveforms 224 Whispering 31 in infants 296 Weakness 81, 139, 140 White cell count 21 see also Diaphragm White out on x-ray 38 Yoga 64, 165